Provider Demographics
NPI:1922379312
Name:CARROLL, MEGAN (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 THOROUGHBRED TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:815-880-5122
Practice Address - Street 1:47W635 BEITH RD
Practice Address - Street 2:
Practice Address - City:MAPLE PARK
Practice Address - State:IL
Practice Address - Zip Code:60151-8802
Practice Address - Country:US
Practice Address - Phone:630-945-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009616225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist